Tuesday, November 8, 2011

The Michael Jackson trial and the doctor as drug dealer


Medication: just what the stressed pop star wants


If you wanna feel real nice

Just ask the rock n roll doctor tonight


Those lambent lyrics come, of course, from the great Lowell George in his masterly "Rock n Roll Doctor". Poor George could have done with the services of a decent medic himself, dying as he did at the terribly young age of 34 – leaving a daughter, Inara – from complications following a drug overdose (probably a speed ball, a mixture of heroin and cocaine taken intravenously, though it depends on which account you read).


I have this to add to Neil McCormick's wise words on Conrad Murray and Michael Jackson: that "personal physician" (PP) is a show business concept through and through. Only in show business do young, healthy individuals require their own doctor, paid a retainer to look after only one patient, all year round, often night and day. The job description is likely to emphasise keeping the show on the road – and keeping the performer upright and coherent. This is not always an easy task, as Dr George Nichopolous ("Dr Nick"), Elvis Presley's personal physician for the last 10 years of life, could surely testify. Elvis in the 1970s concerts could often be seen clinging to the microphone stand for dear life, as if it was the only thing holding him up.


The only other people I can think of, apart from singers and film stars, who have this kind of round-the-clock medical care are dictators. Most people, after all, don't need to see a doctor unless they're ill. This fact – that the star is basically young and fit – points to the unusual role of the PP.


The PP aims to make his patient "better than well". This involves any amount of wacky nostrums. A favourite over the years has been B12 injections, designed to boost performance, usualy administered in the muscle of the hip or bum. A lot of these pick-me-ups have speed, amphetamine, as the active ingredient. For example, Max Jacobson, JFK's physician, added a brain-bursting 30 to 50mg of amphetamine to his booster shots, in addition to "multivitamins, steroids, enzymes, hormones, and solubilized placenta, bone marrow, and animal organ cells", it is said.


No wonder Dr Jacobson boasted that his customers "went out the door singing". And no wonder his list of show business patients was so long, and adorned with such stellar names as Anthony Quinn, Tennessee Williams, Eddie Fisher, Truman Capote and Alan Jay Lerner.


The question always arises: how culpable are these doctors if their clients drop dead of the drugs they're prescribed? Well, these days the doctors cannot get away with saying they didn't know what they were getting in to. The path is well-trodden by now: spoilt, headstrong, infantile and tantrum-prone star who's bored and unhappy and wants to sleep a lot; compliant doctor who yields too easily to the patient's demands – for if he doesn't prescribe the dangerous medicines, someone less responsible happily will, or so the argument goes.


It's hard to think that, these days, any respectable doctor would willingly take on a patient like Michael Jackson as Conrad Murray did: it's just too risky. It is also a fundamentally corrupt and corrupting therapeutic relationship – a sick relationship.


The doctor's proper job, to paraphrase Sir William Osler's dictum, is to persuade his patients not to take medicine. Yet in these cases his job, tacitly understood, is prescribe – generously. And there are other pitfalls. For one thing, no doctor should be entirely financially dependent on his patient. For another, it is not healthy for a doctor to be star-struck, though this must happen often: Dr Nick was in awe of Elvis, for instance, and it's hardly surprising – Elvis was the greatest popular singer who has ever lived. Dr Nick also erred a bit, I'm afraid, by entering into business deals with Elvis over racketball courts, and receiving fabulous presents. What's more, it is unwise for a doctor to have only one patient.


Where I think we do go wrong, however, is in pinning all the blame on the doctor for celebrity deaths, as has happened with Conrad Murray. This is naive, and it removes responsibility from the real actor – the patient. The patient wills his own destruction in these cases, one way or another. The doctor is only a tool.



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